Abstract: Objective We calculated the stress hyperglycemia ratio (SHR) using pre-thrombolysis random blood glucose (RBG) and fasting blood glucose (FBG) to glycosylated hemoglobin on the first morning after admission to assess the association of SHR with early neurological improvement (ENI) in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA). Methods The clinical data of 85 AIS patients treated with intravenous thrombolysis with r-tPA were analyzed. SHR1 was defined as [RBG (mmol/L)]/[HbA1c(%)], and SHR2 as [FBG (mmol/L)]/[HbA1c(%)]. The relationship between SHR and ENI was analyzed. Results Univariate analysis showed that the median SHR2 of the ENI group was 0.87, lower than that of the non-ENI group, which was 1.03 (Z=-3.012,P<0.05). There was no significant difference in SHR1 between the two groups. In patients without diabetes, the AUC of ENI was 0.674, the optimal diagnostic threshold was 0.9, the sensitivity was 85%, and the specificity was 57.1%. Conclusion SHR promises to be a predictor of ENI after thrombolysis.

Key words: Acute ischemic stroke, Stress hyperglycemia ratio, Intravenous thrombolysis, Early neurological improvement, Fasting blood glucose